In the rural areas, after all the treatment modalities - the physician's, the albularyo's, the hilot's, and other healers - have failed, patients and families often resign to the possibility that the illness was caused by "kulam" - a spell, na-kulam, na-enkanto, na-nuno, na-duwende, or na-asuwang. These various modalities of hexing or spell-casting continue to be prominent in the mythology and rural tenets of health and healthcare.

The treatment modality, considered by some as another form of prayer, is usually in the purview of an albularyo who has specialized in the craft of antidotes and counter-spells (pangkontra).

Sometimes, the spell or counter-spell is written in a piece of paper (left insert) with the name of the involved person, and is 'pinned' with needles, small nails or pins.

Although "kulam' conjures up images of full moons, howling dogs, needles and rag-dolls, it is, as often, dispensed as "good spells" concocted for an endless variety of mundane concerns.

A book on "Kulam" by Tony Perez is a compendium of such spells, for day-to-day needs: for good fortunes, against bad luck, to improve the appetite, to protect a loved one, to prevent nightmares, to become attractive to someone or to counter bad thoughts. It expounds on the craft with new-age element; 20-minute spells that are prayer-based, meditative, inner-healing, life-force driven with easy ingredient accessibility. Also, it proposes that anyone can learn to practice the craft.